TY - JOUR T1 - Renal graft survival according to Banff 2013 classification in indication biopsies JO - Nefrología (English Edition) T2 - AU - Arias-Cabrales,Carlos AU - Redondo-Pachón,Dolores AU - Pérez-Sáez,María José AU - Gimeno,Javier AU - Sánchez-Güerri,Ignacio AU - Bermejo,Sheila AU - Sierra,Adriana AU - Burballa,Carla AU - Mir,Marisa AU - Crespo,Marta AU - Pascual,Julio SN - 20132514 M3 - 10.1016/j.nefroe.2016.05.012 DO - 10.1016/j.nefroe.2016.05.012 UR - https://www.revistanefrologia.com/en-renal-graft-survival-according-banff-articulo-S201325141630147X AB - IntroductionThe impact of acute rejection in kidney graft survival is well known, but the prognosis of other diagnoses is uncertain. We evaluated the frequency and impact on graft survival of different diagnostic categories according to the Banff 2013 classification in a cohort of renal transplant recipients. Material and methodsRetrospective study of 495 renal biopsies by indication in 322 patients from 1990 to 2014. Two independent observers reviewed the histological reports, reclassifying according to the Banff 2013 classification. ResultsOf 495 biopsies, 28 (5.7%) were not diagnostic. Of the remaining 467, 10.3% were “normal” (category 1), 19.6% antibody-mediated changes (category 2), 5.9% “borderline” changes (category 3), 8.7% T-cell-mediated rejection (category 4), 23.4% interstitial fibrosis/tubular atrophy (IFTA) (category 5) and 26.5% with other diagnoses (category 6). As time after transplantation increases, diagnoses of categories 1, 3 and 4 decrease, while categories 5 and 2 increase. Worse graft survival with category 2 diagnosis was observed (45% at 7.5 years, HR 4.29 graft loss [95% CI, 2.39–7.73]; P≤0.001, compared to category 1). Grafts with “unfavourable histology” (chronic antibody-mediated rejection, moderate-severe IFTA) presented worse survival that grafts with “favourable histology” (normal, acute tubular necrosis, mild IFTA). ConclusionsThe Banff 2013 classification facilitates a histological diagnosis in 95% of indication biopsies. While diagnostic category 6 is the most common, a change in the predominant histopathology was observed according to time elapsed since transplantation. Antibody-mediated changes are associated with worse graft survival. ER -